Chiropractic Maintenance Therapy Not Covered
To meet Medicare coverage criteria, chiropractic treatment should be aimed at treating acute injuries, re-injuries, or exacerbations. The result of chiropractic manipulations is expected to be an achievable improvement and with a clearly defined end point. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered medically necessary under the Medicare program.
Maintenance therapy is defined by Medicare as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition. Therefore, Medicare does not cover maintenance therapy. For additional clarification of the coverage criteria for chiropractic services, refer to your MAC’s Local Medical Review Policy.